经尿道前列腺180W直出式绿激光汽化切除术治疗前列腺增生的临床疗效观察

Transurethral 180W front-firing GreenLight laser vaporization of the prostate for the treatment of benign prostatic hyperplasia

目的:评估经尿道前列腺180 W直出式绿激光汽化切除术(PVP)治疗BPH的临床疗效和安全性。方法:分析安庆市立医院2019年3~12月61例接受手术治疗的BPH患者的临床资料(对照组31例,接受经尿道前列腺等离子电切术;观察组30例,行经尿道前列腺180 W直出式绿激光汽化切除术),收集两组术前、术中、术后相关临床数据,并对数据进行对比研究。结果:所有患者手术均获成功,未见输血,未见严重并发症。观察组手术时间、术中失血量、术后膀胱灌洗时间、留置尿管时间、术后住院时间均小于对照组[(57.5±19.0)vs(75.0±9.9)min,(48.8±9.6)vs(62.3±15.9)ml,(25.2±11.5)vs(64.4±10.5)h,(2.5±0.5)vs(5.1±0.5)d,(4.1±0.6)vs(7.3±1.7)d],两者比较具有统计学差异(P<0.05)。术后围手术期并发症方面,术后血尿发生率观察组明显少于对照组[0(0/30)vs 12.9%(4/31)],两者比较具有统计学差异(P<0.05);两组在包膜穿孔、TURS、尿失禁、尿道狭窄及拔管后尿潴留发生率比较无统计学差异。两组术前、术后IPSS、Qol、最大尿流率(Qmax)、残余尿量(PVR)比较有显著统计学差异(P<0.05)。结论:经尿道前列腺180 W直出式绿激光汽化切除术治疗前列腺增生,与经尿道等离子电切术相比较更安全有效,但绿激光汽化切除术出血更少,留置尿管时间更短,恢复更快。遇有服用抗凝血药物者无需停药,特别适合高龄、高危前列腺增生患者。

Objective:To evaluate the clinical effect and safety of transurethral 180 W front-firing GreenLight laser vaporization of the prostate(PVP)in the treatment of benign prostatic hyperplasia(BPH).Methods:A total of 61 BPH patients underwent 180 W front-firing GreenLight laser PVP(n=30,the PVP group)or transurethral plasmakinetic resection of the prostate(n=31,the control group)from March to December 2019.We collected the pre-,intra-and post-operative clinical data and compared them between the two groups of patients.Results:Operations were successfully completed in all the cases with no blood transfusion or serious complications.Compared with the controls,the patients of the PVP group showed remarkably less intra-operative blood loss([62.3±15.9]vs[48.8±9.6]ml,P<0.05),shorter operation time([75.0±9.9]vs[57.5±19.0]min,P<0.05),postoperative bladder lavage time([64.4±10.5]vs[25.2±11.5]h,P<0.05),catheter-indwelling time([5.1±0.5]vs[2.5±0.5]d,P<0.05)and hospitalization time([7.3±1.7]vs[4.1±0.6]d,P<0.05),and a lower incidence of postoperative hematuria(12.9%[4/31]vs 0%[0/30],P<0.05).No statistically significant differences,however,were found between the two groups in the incidence rates of capsular perforation,transurethral resection syndrome(TURS),urinary incontinence,urethral stricture and post-extubation urinary retention.Significant improvement was observed in IPSS,QOL,Qmax and PVR in both groups post-operatively(P<0.05).Conclusion:Compared with transurethral plasmakinetic resection of the prostate,180 W front-firing GreenLight laser PVP,with the advantages of less bleeding,shorter catheter-indwelling time and faster recovery,is safer and more effective for the treatment of BPH,with no need for drug withdrawal for those taking anticoagulants,and especially applicable to the elderly and high-risk patients.